What is Age-Related Macular Degeneration & Does AREDS2 Help?

August 16, 2018 5 min read

Woman with teal and hazel eyes

We take our vision for granted but a life without vision would be unimaginable for most of us. That is why it is so important to take good care of the health of our eyes.

Eye test for Macular Degeneration

Major causes of vision loss include cataracts (where the lens of the eye grows opaque or solid color blocking vision), glaucoma (where the pressure inside the eye gets too high damaging the eye’s components), and age-related macular degeneration, which will be discussed further later in this article.

Age-related macular degeneration causes central vision loss.

It comes in two different flavors – wet and dry. The “dry” form (which is much more common) is believed to result from the buildup of abnormal bundles of proteins and lipids (fats) that deposit between the retina (the area at the back of eye where nerve cells that detect light reside) and the choroid (the blood vessel layer of the eye).

These protein and lipid deposits are called drusen, and one of the bad proteins found in drusen is beta-amyloid, the same protein that deposits abnormally in Alzheimer’s disease. For this reason, age-related macular degeneration has sometimes been referred to as “Alzheimer’s of the eye.

“Dry” age-related macular degeneration progresses slowly.

There is no effective treatment to stop the worsening of this type of macular degeneration, and 80-90% of people affected by age-related macular degeneration have this form.

The less common “wet” version of age-related macular degeneration is caused by the growth of too many blood vessels in the choroid, which can leak fluid and blood causing rapid vision loss.

An FDA approved drug to treat “wet” macular degeneration came to market in December 2004. There are now three FDA-approved drugs with this indication. The drugs are injected into the eye, where they inhibit the abnormal and excessive growth of blood vessels.

Woman putting eye drops into her eyes

Laser coagulation therapy (using lasers to destroy blood vessels), is an approved treatment of “wet” macular degeneration, but it is not the preferred treatment recommended by the American Academy of Ophthalmology.

Oxidative stress, the production of highly reactive oxygen species that occurs during routine metabolism, can wreak havoc on the cells components and function. It is thought to play a key role in the development of age-related macular degeneration due to its effects on the retina.

This was suggested by studies conducted on both live animals and on cell cultures. Nutrient supplementation is a powerful tool in promoting health and preventing disease and can be used to counteract oxidative stress. Furthermore, it allows individuals to take control over their own health.

For this reason, a large multi-center clinical trial, AREDS (Age-Related Eye Disease Study), was conducted between 1992 and 2001 by the National Eye Institute, a division of the National Institutes of Health, and published in 2001. AREDS investigated the effect of high dose antioxidant supplementation combined with the mineral zinc on eye health.

Specifically, the study randomly assigned study participants, a total of 3640 individuals between the ages of 50 and 85, one of the following: high dose antioxidants (including vitamin C 500 mg, vitamin E 400 IU, and beta-carotene 15 mg), zinc 80 mg with 2 mg copper, antioxidants plus zinc, or placebo (a pill with no active ingredient).

Results from the study showed that a combination of vitamin C, vitamin E, beta carotene, and zinc significantly reduced the progression to severe macular degeneration by twenty-five percent without serious side effects.

However, other studies have suggested that beta-carotene supplementation raises the risk of lung cancer among current and former smokers. Cigarette smoking is a strong risk factor for developing age-related macular degeneration. Because of these safety concerns and to see if the original formula could be improved upon, a new supplement formulation was devised and tested in another large clinical trial known as AREDS2.


AREDS2 was conducted from 2006 through 2012, enrolling 4203 study participants between the ages of 50 and 85, with results published in 2013. It investigated the effects of adding lutein and zeaxanthin as well as long-chain omega 3 fatty acids to the original AREDS formula.

The study authors also wanted to see if lutein and zeaxanthin could substitute for beta-carotene and thus eliminate the increased risk of lung cancer in current and former smokers suggested by prior studies.

Beta carotene, lutein, and zeaxanthin all come from the same family of molecules that help absorb light in plants and protect against radiation damage caused by sunlight. A secondary analysis showed that lutein and zeaxanthin could effectively substitute for beta-carotene and still significantly reduce the progression to severe macular degeneration. Lutein and zeaxanthin did not increase the risk of developing lung cancer in current and prior smokers.

AREDS2 did not show that long chain omega 3 fatty acid consumption impacted the progression of age-related macular degeneration.

However, DHA (one of the two omega 3 fatty acids assessed in the study, the other one being EPA) does make up a third of the fatty acids found in the retina. While omega 3 fatty acids may not significantly impact the progression of vision loss from moderate to severe stages of macular degeneration, there is some evidence that the combination of DHA plus EPA, zinc, beta-carotene, and lutein plus zeaxanthin reduces the risk of developing early onset macular degeneration in individuals carrying a genetic predisposition towards the condition.

Another study, conducted in Germany, found that taking supplements containing omega 3 fatty acids plus antioxidants along with lutein and zeaxanthin increased the density of the pigmented (colored) cells in the retina that process central vision (the same area of the retina affected by macular degeneration).

What are things that people can do to protect the health of their eyes?

Infographic sharing 8 tips for eye health

One very important way to take care of your eyes is to have a dilated eye exam performed by a physician who specializes in the treatment of eye diseases, called an ophthalmologist.

By dilating your pupil and examining the back of the eye, diseases such as glaucoma, cataracts, and age-related macular degeneration can be discovered at an early stage.

Early intervention with supplements in the case of macular degeneration might prevent its onset or at least slow the progression of the disease. There is also evidence that antioxidant vitamins, particularly vitamin E, could decrease the chance of developing cataracts. Lutein and zeaxanthin might also protect against the formation of cataracts.

Physicians Choice has developed a premium AREDS2 based formula which includes clinically proven Lutemax 2020®,vitamin C, vitamin E, zinc plus copper, and high potency extract of Lutein & Zeaxanthin amongst other ingredients to promote eye health, informed by the results of AREDS2.

In addition to supplements, green leafy vegetables, such as kale, spinach, collard greens, turnips, romaine lettuce, and broccoli, as well as other foods such as eggs, avocado, and corn are great dietary sources of lutein and zeaxanthin. Quitting cigarette smoking is also very important to eye health.

When it comes to preventing and reducing cataract formation, decreasing eye exposure to radiation from the sun by putting on UVA/ UVB protective sunglasses and wearing wide-brimmed hats can be helpful.

Working with your primary care doctor to treat diseases that impact the entire body including the eyes, such as diabetes and high blood pressure, is also vital to eye health.

General health measures such as diet and exercise, good sleep hygiene, and adequate hydration can do your eyes, as well as your body, a world of good. Avoiding eye strain and wearing protective equipment such as goggles when doing yard work or other activities that might lead to eye injury via air-borne objects are other common-sense measures to ensure healthy eyes.